MN／CA9和Ep-cam基因检测在良恶性胸腔积液鉴别中的价值

Detection of MN/CA9 and Ep-cam mRNA in distinguishing between benign and malignant pleural effusion

目的探讨MN／CA9和Ep—cam基因检测对良、恶性胸腔积液鉴别诊断的价值。方法选择35例恶性胸腔积液（MPE）和30例良性胸腔积液（BPE），采用SYBRGreenIFQRT—PCR检测胸水沉淀细胞中MN／CA9mRNA、Ep—cammRNA的表达，胸水找脱落细胞，免疫化学发光法检测胸水CEA水平。结果MN／CA9和Ep—cam基因在良、恶性胸腔积液中的表达均有明显差异（均P〈001）。对MPE的诊断，用FQRT—PCR方法检测MN／CA9mRNA和Ep—cammRNA的敏感性（SN）均高于其它两项检查，差异均有统计学意义（均P〈005），而特异性（SP）无统计学差异（均P〉0．05）。细胞学阴性的MPE，MN／CA9诊断的SN为55．6％，SP为100％；Ep—cam诊断的SN为61.5％，SP为100％；两者联合检测的细胞学阴性MPE的SN为76．9％，SP为100％。结论SYBRGreenIFQRT—PCR检测MN／CA9和Ep—cam基因有助于鉴别良、恶性胸腔积液；联合检测MN／CA9和Ep—cam基因的表达有助于提高细胞学阴性MPE诊断的敏感性。

Objective To investigate the value of expression of the MN/CA9 and Ep-cam mRNA in distinguishing malig- nant pleural effusion （MPE） from benign pleural effusion（BPE）. Methods The pleural fluid specimens were collected from 35 pa- tients with MPE and 30 patients with BPE. The expression of MN/CA9 mRNA and Ep-cam mRNA were detected by SYBR Green I fluorescence quantitative reverse transcription polymerase chain reaction （FQ-RT PCR） in cell pellets. Exfoliated cell cytology and carcinoembryonic antigen （CEA） assay were performed in effusion specimens. Results There were significant differences in expression of MN/CA9 mRNA and Ep-cam mRNA between MPE and BPE （P〈0.01）. The diagnostic sensitivity （SN） for MPE by MN/CA9 and Ep-cam mRNA expression were much higher than that of exfoliated cytology and CEA assay （P〈0.05）, but no difference in specificity（P 〉0.05）. The diagnostic sensitivity of MN/CA9 and Ep-cam mRNA expression in MPE with negative cy- tology was 55.6% and 61.5%, respectively; both had a specificity of 100.0%. The combination of MPE and MN/CA9 mRNA detec- tion had a sensitivity of 76.9% and specificity of 100.0%. Conclusion The detection of MN/CA9 and Ep-cam mRNA by SYBR Green I FQ RT-PCR is of value in distinguishing MPE from BPE with. In cytologically negative MPE the combined detection of MN/CA9 and Ep-cam mRNA expression may improve the diagnostic sensitivity.